Provider Demographics
NPI:1124562111
Name:GRIFFIN, CORY EDWIN (PTA)
Entity type:Individual
Prefix:MR
First Name:CORY
Middle Name:EDWIN
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2564
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-362-8684
Practice Address - Street 1:1438 HIGHWAY 16 W STE C
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-2096
Practice Address - Country:US
Practice Address - Phone:770-233-0350
Practice Address - Fax:770-233-0370
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPTA003469225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant